What are investigations for diagnosing Pulmonary Embolism?

A definitive diagnosis of Pulmonary Embolism requires a CTPA (computed tomography pulmonary angiogram). It is a non-invasive and safe procedure that helps visualise the location of the clot by injecting a dye (contrast) into the blood stream. Other related investigation are venous Doppler ultrasound of the lower limb for deep vein thrombosis also known as DVT, echocardiogram which shows the effect of the pulmonary embolism on the heart, blood test called D-Dimer, troponin, Pro bnp and ECG are also done simultaneously.

In certain cases, such as when people are suffering from kidney diseases or with history of dye (contrast) induced allergies an alternate to CTPA, is a V/Q scan. A V/Q or ventilation-perfusion scan, is a two-step method to assess the flow of the air (ventilation) and blood (perfusion) in the lungs, using radioactive material that is safe for clinical use.


 Who treats pulmonary embolism?

A multidisciplinary team is required for the management of pulmonary embolism which includes a pulmonologist, interventional radiologist, cardiologist and occasionally a hematologist.


Can pulmonary embolism be treated?

Yes, both acute and chronic pulmonary embolism are treatable. There are medical and invasive or surgical options available. The choice of treatment is selected on basis of severity of the condition and patient’s prior existing illnesses.

Medical options include blood thinners or “anticoagulants”, which prevent the existing clots from increasing in size as well as the development of new clots. Blood dissolvers or “thrombolytics”; these drugs dissolves the clots. Risk of bleeding with these medications is high and hence must be administered under a strict,  monitored environment. These medications are available in injectable forms as well as oral.

In certain situations, some invasive procedures like placing a filter (IVC Filter), in a big vein that leads from the leg to the heart. The filter prevents the clot from travelling into the lungs. These procedures also include a removal of the clot, by breaking, sweeping or aspirating with a catheter. Catheter guided thrombolysis, is a technique that uses x-ray imaging to guide a thrombolytic agent into the clot to dissolve it. These procedures are performed by a interventional radiologist.

Surgical embolectomy is another surgical procedure performed by cardiothoracic surgeons, under general anesthesia. It is like an open heart surgery in which the involved vessel is opened up the clot is removed.

Anticoagulants are given for long term duration as decided by your treating physician according to the individual case.


Do I need to be admitted to a hospital for the treatment of pulmonary embolism?

Yes, a patient symptomatic for pulmonary embolism should be admitted in a hospital. Response to the treatment and any possible adverse effects needs to be monitored and managed closely and effectiely.


Is Pulmonary Embolism life threatening?

A mild pulmonary embolism usually does not cause any series problems. If a pulmonary embolism is massive, it causes severe complications with decreased oxygen, low blood pressure and severe strain to the heart. Such a severe condition if left untreated can be fatal. Such patients, who are high risk should be admitted to in an intensive care unit under the care of a critical care specialist known as an intensivist.


Can the clot from the lungs travel to any other parts of the body?

There is no evidence that a clot from the lungs can travel to other parts of the body.


Can a clot from the leg cause heart attack or stroke?

DVT is a clot in the vein of the leg. This type of clot does not cause heart attack or stroke.


When is it safe for me to walk if I have DVT (deep vein thrombosis)?

Yes, one can be mobilized. Once the treatment is initiated the primary physician will decide the time when a patient can safely be allowed to walk.


Does pulmonary embolism recur?

There are certain risk factors present in an individual that can put them at the risk of developing DVT and pulmonary embolism again even after completion of initial treatment. Your treating physician will identify the risk factors and will make a long term treatment regarding treatment with  anticoagulation.


Are there any side effects of long-term anticoagulation?

With all anticoagulant, a risk of bleeding is a major concern. Frequent check of blood hemoglobin is advised to keep a track of any drop in hemoglobin levels. One must avoid contact sports, use shavers or razors with great care and avoid excessive use of sharp objects. Bleeding can also take place from certain parts of the body like bleeding while passing stool, in urine, vomiting or with cough. If you experience any bleeding, you must contact your primary physician or your medical specialist for further guidance.


When is it safe for me to travel by plane if I have pulmonary embolism or DVT?

There are no clear studies regarding the risk of air travel for such individuals. Some experts recommend travel after 4 weeks of treatment for DVT or pulmonary embolism. Seek guidance from your treating physician about the safety for travelling in your individual case.


Can pulmonary embolism recur while I’m taking treatment?

Certain diseases can lead to recurrence of pulmonary embolism.  This requires further investigation and optimization of the treatment. Another reason is noncompliance with the treatment or sub-optimal dosing of the medications. Frequent visit to your health care provider should be made so a periodic reassessment for risk of recurrence is made.


How do I prevent travelling of a clot from Deep vein thrombosis to lung?

Once there is evidence of DVT, appropriate treatment should be started immediately. Early mobilization as advised by the primary physician is extremely important.


Can I prevent Deep vein thrombosis from developing?

An expected long period of immobility in individuals who are at high risk of developing thrombosis may make it necessary for them to take precautions. Early mobilization after major surgeries is recommended. If you are advised for best rest, do physiotherapy of arms and legs frequently. People travelling for extended hours should move about and do leg stretching exercises. Wear compression stocking, while sitting or lying down for long period of time inactivity. Avoid smoking, and hormone replacement or birth control pills. For further information discuss with your physician.


Is the treatment for pulmonary embolism safe in pregnancy?

During pregnancy, injectable anticoagulant drugs are preferred over the oral forms.  Other treatment options like thrombolysis or IVC filter can be considered but with precautions and monitoring.  If being treated as outpatient, a periodic visit to your physician is recommended. For more information visit your obstetrician/gynecologist for further assistance.


Are anticoagulation safe in breast feeding mothers?

Yes, certain anticoagulants can be given to breastfeeding mothers. Monitoring of response of the treatment and related complications should be frequently done.


Should you need to seek the expertise of a pulmonologist and critical care intensivist, please call The Chest Clinic- Dr. Javed Husain & Associates. We offer both online video consultation as well as outpatient clinic and in-hospital care for all our patients. To make an appointment please call +923018479066 or leave us a message by WhatsApp requesting an appointment and a member of our team will call back and connect with you.